The classic course of LGV consists of three stages that can be well distinguished. The incubation period may last up to one month, but symptom onset may also occur after a few days [9].

A primary lesion may form on vulva, vaginal mucosa or cervix, on the glans penis, most commonly on the coronal sulcus, in the urethra or rectum of both women and men. Depending on its precise location, it may go unnoticed unless mucopurulent discharge attracts the attention of the affected individual. It may appear as a papule or nodule, erode and ulcerate. If the latter is the case, hemorrhages may be reported. Contrary to lesions associated with genital herpes, pain and pruritus are generally absent. The primary lesion spontaneously remits after about one week.

The first stage of the disease is followed by a latency period of several weeks. The second stage of LGV is characterized by unilateral, rarely bilateral, lymphadenopathy; distinct lymph nodes may be affected dependent on the site of inoculation. In heterosexual men and some women, i.e., in those patients that presented the initial lesion in the anterior pubic area, inflammation of inguinal and external iliac lymph nodes occurs. In the developing world, this is the most common course of the disease, which is therefore often described as "genital ulcers and inguinal lymphadenopathy". Swelling and pain may be noted, but abscesses may also form in affected lymph nodes. They are commonly referred to as buboes, may rupture and drain into sinus tracts. In contrast, if inoculation occurs in the posterior pubic region, in the posterior parts of vulva and vagina, or in the rectum of women or men, pathogens may reach the perirectal and internal iliac lymph nodes. Here, lymphadenopathy provokes abdominal and lower back pain, but swollen lymph nodes are not palpable. Reactive arthritis has been reported to develop during the second stage of LGV [10].

If not adequately treated, the infection may persist for years and trigger a chronic inflammatory response. Extensive tissue damage, abscess and fistula formation, and, in case of anal infections, proctitis, strictures and stenosis of the rectum may occur during this third stage of LGV. Genital edema and lymphorrhoids are sometimes observed. These sequelae result from chronic lymphangitis, chronic edema and fibrotic remodelling processes.

Considering recent outbreaks in the developed world, presentation is more homogeneous. Most patients are homosexual or bisexual men and they usually suffer from hemorrhagic proctitis during early stages of the disease. This condition is painful and is often associated with anorectal bleedings and tenesmus.

• Inguinal Lymphadenopathy

  The diagnosis usually is made serologically (through complement fixation) and by exclusion of other causes of inguinal lymphadenopathy or genital ulcers. Serologic testing has a sensitivity of 80% after 2 weeks. [en.wikipedia.org]

  Lymphogranuloma venereum (LGV) is a sexually transmitted cause of inguinal lymphadenopathy and proctocolitis. We report a patient with a persistent genital ulcer due to LGV (serovar L2b), an unusual presentation among US men who have sex with men. [ncbi.nlm.nih.gov]

• Generalized Lymphadenopathy

  Lymphoma Lymphoma will usually be associated with constitutional symptoms and generalized lymphadenopathy. Diagnosis of lymphoma is made by histopathology from a lymph node biopsy. Incarcerated inguinal hernia Differential for an inguinal mass. [online.epocrates.com]

  HIV and lymphoma can also cause generalized lymphadenopathy. Dermatological conditions and trauma which can cause genital ulcerations should also be in the differential diagnosis. Prognosis Prognosis is fair if recognized and treated early. [ncbi.nlm.nih.gov]

• Fever

  Patients with second-stage LGV may also have fever, nausea, headaches, pains in their joints, skin rashes, and enlargement of the spleen or liver. [medical-dictionary.thefreedictionary.com]

  The symptoms can sometimes be severe with fevers and feeling generally unwell. Testing (rectal swab) needs to be done at a specialised sexual health clinic. LGV is easily treated with 3 weeks of antibiotics. [sexualhealthkingston.co.uk]

  Other symptoms include malaise, fever, chills, joint and muscular pain and vomiting. 3 Most female patients present during this stage with fever, pain, itch, pain on passing stools and urinating, and pus-filled or bloody diarrhoea. [dermnetnz.org]

• Chills

  These include fever, chills, fatigue, muscle and joint aches, lymph node swelling, genital scarring, and rectal disease. Causes LGV can be transmitted through unprotected oral, vaginal or anal sex with a person who is already infected. [gov.mb.ca]

  Further symptoms are fever and chills. Diagnosis Serologic testing: Method of choice for the detection of Chlamydia trachomatis is via DNA testing from lymph node aspiration specimen or from the genital ulcer. [urology-textbook.com]

  Other symptoms include malaise, fever, chills, joint and muscular pain and vomiting. 3 Most female patients present during this stage with fever, pain, itch, pain on passing stools and urinating, and pus-filled or bloody diarrhoea. [dermnetnz.org]

• Malaise

  It is characterized by ulcerative genital lesions, marked swelling of the lymph nodes in the groin, headache, fever, and malaise. Ulcerations of the rectal wall occur less commonly. [medical-dictionary.thefreedictionary.com]

  A 21 year old woman presented with painful groin lymphadenopathy and malaise. Lymph node biopsy, to exclude atypical infection and malignancy, suggested the diagnosis of lymphogranuloma venereum. [ncbi.nlm.nih.gov]

  The buboes stick to deeper tissues and cause the overlying skin to become inflamed, sometimes with fever and malaise. [msdmanuals.com]

  Other symptoms include malaise, fever, chills, joint and muscular pain and vomiting. 3 Most female patients present during this stage with fever, pain, itch, pain on passing stools and urinating, and pus-filled or bloody diarrhoea. [dermnetnz.org]

• Lymphedema

  Usually, the disease is divided into three phases: the primary stage characterized by a self-healing papule, the secondary stage characterized by proctitis or lymphadenopathy and the tertiary stage characterized by lymphedema and anal strictures. [ncbi.nlm.nih.gov]

  […] myalgia, arthralgia, hepatitis, conjunctivitis, erythema nodosum Lab Antibody assays–eg, immunofluorescence, counterimmunoelectrophoresis, complement fixation titers > 1:32 Treatment Tetracycline, excision Late complications Urethral, rectal strictures, lymphedema [medical-dictionary.thefreedictionary.com]

  Chronic inflammation can lead to scarring and fibrosis causing lymphedema of the genitals, or formation of strictures and fistulae if anorectal involvement. [bestpractice.bmj.com]

  These include lymphedema and elephantiasis of the external genitourinary organs. The lesions are more often found in women, typically on the labia, which are swollen and undergo papillary hyperplasia. [empendium.com]

• Chronic Infection

  Lymphogranuloma venereum (LGV) is a sexually transmitted infection (STI). LGV is a long-term (chronic) infection of the lymphatic system. It is caused by certain strains of the bacteria Chlamydia trachomatis. [medlineplus.gov]

  infection of the lymphatic system caused by three strains of the bacterium Chlamydia trachomatis. [clinicalinfo.hiv.gov]

  Chronic inflammation may lead to abscesses, fistulas, lymphatic obstruction, rectal strictures and proctocolitis. Chronic infection may result in severe scarring causing major deformation of the genitals. [dermnetnz.org]

  Alternative Names LGV; Lymphogranuloma inguinale; Lymphopathia venereum Causes Lymphogranuloma venereum (LGV) is a long-term (chronic) infection of the lymphatic system. [ufhealth.org]

• Tenesmus

  In multivariate analysis, tenesmus and constipation alone were suggestive of LGV (OR 2.98, 95% CI 0.99 to 8.98 and 2.87, 95% CI 1.01 to 8.15, respectively) and that tenesmus alone or in combination with constipation was a significant predictor of LGV [ncbi.nlm.nih.gov]

  Swollen groin lymph nodes on one or both sides; it may also affect lymph nodes around the rectum in those who have anal intercourse * Drainage from lymph nodes in groin * Blood or pus from the rectum (blood in the stools) * Painful bowel movements (tenesmus [checkorphan.org]

• Rectal Discharge

  Smears taken from the rectal discharge were stained by the direct immunoperoxidase assay and showed inclusion bodies with positive staining. [ncbi.nlm.nih.gov]

  Most infections are caught through anal sex – this leads to inflammation in the rectum or ‘proctitis’: Anal pain Rectal bleeding Rectal discharge Constipation Feeling of wanting to defecate A small painless ulcer may occur at the site of infection – such [sexualhealthkingston.co.uk]

  Some people with the condition may experience rectal discharge, pain, diarrhea, fever, constipation, secondary bacterial infection, or a rectal or anal stricture. Image Source: Dr. M.A. Ansary / Photo Researchers, Inc. [emedicinehealth.com]

• Rectal Pain

  All five patients infected with serovar L-1 were homosexual men who had symptomatic proctitis characterized by rectal pain, discharge, tenesmus, abnormalities seen on anoscopy, and leukocytes seen on gram stains of rectal specimens. [ncbi.nlm.nih.gov]

  Other symptoms of LGV include lymph node swelling, diarrhea, genital scarring, and rectal pain, mucous discharge, bleeding and diarrhea. Causes LGV can be transmitted through anal, oral, or vaginal sex with a person who is already infected. [gov.mb.ca]

  Primary lesion Includes a painless papule, pustule or ulcer on the skin of an exposed site usually in the ano-genital or oral area Proctitis which may be haemorrhagic and include symptoms of rectal pain, anorectal bleeding, mucoid discharge, tenesmus, [sahealth.sa.gov.au]

  Patients present with rectal pain often accompanied by bleeding with fever, chills and weight loss. Inoculation outside the genitals may also occur, resulting in swollen glands, for example in the neck following oral sex. [stdclinic.ie]

  Proctitis is characterised by rectal pain, bleeding, rectal discharge, tenesmus and changed bowl habit. [ww2.health.wa.gov.au]

• Abdominal Pain

  It may also affect lymph nodes around the rectum in those who have anal intercourse drainage through the skin from lymph nodes in groin blood or pus from the rectum, or blood in your poo painful bowel movements diarrhoea and lower abdominal pain Women [umbrellahealth.co.uk]

  We present two young black women who suffered from chronic diarrhoea, abdominal pain and weight loss. There was no previous history and investigations showed in both cases a long rectal stricture. Serology was positive in one patient. [ncbi.nlm.nih.gov]

  In some cases LGV causes a fever (high temperature), fatigue and abdominal pain. [ishs.org.uk]

  […] in the groin area Swelling of the labia Swollen groin lymph nodes on one or both sides; it may also affect lymph nodes around the rectum in people who have anal intercourse The infection can also cause diarrhea and lower abdominal pain. [thestdproject.com]

• Perianal Ulcer

  Two cases of HIV-infected patients presenting with isolated perianal ulcer disease are reported here. Both cases were confirmed to have rectal Chlamydia trachomatis-specific DNA of an LGV associated serovar. [ncbi.nlm.nih.gov]

  Singhrao T, Higham E, French P (2011) Lymphogranulomavenereum presenting as perianal ulceration: an emerging clinical presentation?Sex Transm Infect 87: 123-124. [omicsonline.org]

  Lymphogranuloma venereum presenting as perianal ulceration: an emerging clinical presentation? Sex Transm Infect. 2011; 87 (2): 123-124. Ceovic R, Gulin SJ. Lymphogranuloma venereum: diagnostic and treatment challenges. [medigraphic.com]

  Moreover, chlamydia diagnostic is performed on all genital and perianal ulceration to exclude inguinal forms of LGV. [journals.lww.com]

• Myalgia

  […] then matted and painful loco-regional–inguinal and perirectal–lymphadenopathy, described as 'kissing' lesions with a 'groove' sign, sloughing of skin, purulent drainage, hemorrhagic proctocolitis, malaise, fever, headache, aseptic meningitis, anorexia, myalgia [medical-dictionary.thefreedictionary.com]

  Patients with lymphogranuloma venereum usually present with lymphadenopathy, with or without systemic signs and symptoms, such as fever, chills, myalgias, arthralgias, headache, anorexia, and meningismus. [histopathology-india.net]

  Constitutional symptoms associated with the second stage include fever, chills, myalgias, and malaise. [emedicine.medscape.com]

  Unilateral or sometimes bilateral involvement of the inguinal lymph nodes is seen with associated fever, myalgia and arthralgia. Most men present during this stage. [aocd.org]

• Blister

  Symptoms happen in three stages: First stage: You develop small blisters (usually 1 to 6 millimeters in size) filled with fluid on your penis or in your vagina. These blisters usually don’t cause pain and heal quickly. [my.clevelandclinic.org]

  In the first stage, a small, painless, fluid-filled blister develops, usually on the penis or in the vagina. Typically, the blister becomes a sore that quickly heals and is often unnoticed. The second stage usually begins after about 2 to 4 weeks. [msdmanuals.com]

  Following initial exposure, there is mild, blister-like formation which is frequently unnoticed. Within the following month, there is ulceration of the vaginal, rectal or inguinal areas. [brooksidepress.org]

  Signs and Symptoms of Lymphogranuloma Sores resembling pimples or blisters may appear where the bacteria entered the body, but not always. They often heal quickly, without leaving a scar. [healthcommunities.com]

• Erythema

  We present the case of a 30-year-old HIV-negative man with inguinal type lymphogranuloma venereum accompanied by erythema nodosum. [ncbi.nlm.nih.gov]

  […] presentation Male Female Symptoms Primary: small ulcer/nodule on penis/anus (may go unnoticed) proctitis Primary: small ulcer/nodule on vulva/anus (may go unnoticed) proctitis Secondary: inguino-femoral lymph node swelling and/or discharge (Bubo), +/- erythema [sti.guidelines.org.au]

  The skin may be affected by erythema multiforme, urticaria, erythema nodosum or scarlatiniform rash. There may (rarely) be signs of conjunctivitis, hepatomegaly, meningoencephalitis, pericarditis, pneumonia and arthritis. [patient.info]

• Skin Rash

  Patients with second-stage LGV may also have fever, nausea, headaches, pains in their joints, skin rashes, and enlargement of the spleen or liver. [medical-dictionary.thefreedictionary.com]

  Anyone who has been sexually exposed to an individual with the ulcer or skin rash of syphilis can potentially become infected. [emedicinehealth.com]

• Eczema

  The number of positive reactions was larger than with ordinary eczema tests (patch tests). [docslide.us]

  Eczema/dermatitis -- Sect. 3. Psoriasis -- Sect. 4. Ichthyoses -- Sect. 5. Miscellaneous epidermal disorders -- Sect. 6. Bullous diseases -- Sect. 7. Miscellaneous inflammatory disorders -- Sect. 8. [worldcat.org]

• Skin Ulcer

  If the regional blood supply is compromised, ischemic necrosis and superimposed skin ulceration may ensue. The host immunity is known to inhibit chlamydial replication, but it often does not eliminate the microorganism, resulting in a latent state. [news-medical.net]

• Chancroid

  Diagnosis The differential diagnosis of sexually acquired genital ulceration includes chancroid, herpes simplex, syphilis and donovanosis (granuloma inguinale). [i-base.info]

  This case illustrates that early LGV may mimic other genital ulcer diseases, such as genital herpes or chancroid, especially in HIV infected patients. [ncbi.nlm.nih.gov]

  (A) The eroded purulent ulcer of chancroid is painful and may be associated with painful inguinal adenitis. (... [5minuteconsult.com]

  Fig. 2 291 Ulcus molle-chancroid. [adoc.site]

  Intradermal Reaction for Chancroids With Chancroidal Bubo Pus. Cole, H. N., and Levin, E. A.: J. A. M. A. 105: 2040, 1935. Using an antigen prepared from a proved chancroidal bubo Cole and Levin per- formed 433 intracutaneous chancroidal tests. [docslide.us]

• Salpingitis

  Genital tract infections: vulva, vagina, cervix, toxic shock syndrome, endometritis, and salpingitis. In: Gershenson DM, Lentz GM, Valea FA, Lobo RA, eds. Comprehensive Gynecology. 8th ed. Philadelphia, PA: Elsevier; 2022:chap 23. [medlineplus.gov]

  Genital tract infections: vulva, vagina, cervix, toxic shock syndrome, endometritis, and salpingitis. In: Lobo RA, Gershenson DM, Lentz GM, Valea FA, eds. Comprehensive Gynecology. 7th ed. Philadelphia, PA: Elsevier; 2017:chap 23. [ufhealth.org]

  In females, cervicitis, perimetritis, or salpingitis may occur as well as lymphangitis and lymphadenitis in deeper nodes. [en.wikipedia.org]

• Adnexal Tenderness

  Follow-Up Patients receiving oral or parenteral therapy should demonstrate substantial clinical improvement (e.g., defervescence; reduction in direct or rebound abdominal tenderness; and reduction in uterine, adnexal, and cervical motion tenderness) within [cdc.gov]

• Penile Lesion

  There were no penile or scrotal lesions and no urethral discharge. [journals.lww.com]

  Fig. 1 Ulcerative, painless lesion in a 22 year-old woman, wife of a man who was also diagnosed with LGV Fig. 2 Bubo in a 26 year-old man with cutaneous microabscesses and “watering can sign” aspect Fig. 3 Ulcerative, painless penile lesion and inguinal [bmcinfectdis.biomedcentral.com]

  Painless, swollen glands (lymph nodes) are often present in the region of the chancre, such as in the groin of patients with penile lesions. [emedicinehealth.com]

• Painless Penile Lesion

  Fig. 1 Ulcerative, painless lesion in a 22 year-old woman, wife of a man who was also diagnosed with LGV Fig. 2 Bubo in a 26 year-old man with cutaneous microabscesses and “watering can sign” aspect Fig. 3 Ulcerative, painless penile lesion and inguinal [bmcinfectdis.biomedcentral.com]

If anamnestic data and clinical presentation prompt a suspicion of LVG, lesion or rectal swab specimens or aspirates from buboes should be obtained for further testing. Molecular biological approaches have been proven more reliable than traditional serological testing and bacterial culture. With regards to the latter, serological tests may be sensitive, but are rather unspecific, and culture of Chlamydia is a real challenge - it may be very specific, but is little sensitive.

Any approach chosen should be followed by genotyping, unless both steps can be realized in one single test. C. trachomatis is frequently detected in genital or rectal swabs, but L1, L2 or L3 serovars are rare findings. Because only those serovars are able to induce LGV, a definitive diagnosis cannot be made before genotyping results are available.

Due to the strong correlation between LGV and HIV infections, LGV patients should be tested for HIV infection. Similarly, diseases like hepatitis B, hepatitis C and syphilis are frequently observed in individuals pertaining to risk groups for LVG and thus, it should be ascertained if patients suffer from either of those infectious diseases.

• Chlamydia Trachomatis

  trachomatis) Lymphogranuloma venereum (LGV) is caused by three different types of the bacteria Chlamydia trachomatis. [checkorphan.org]

  Causes and symptoms LGV is caused by Chlamydia trachomatis, a globe-shaped parasitic organism that reproduces only inside of living cells. [medical-dictionary.thefreedictionary.com]

  Lymphogranuloma venereum (LGV) is an invasive ulcerative sexually transmitted infection caused by Chlamydia trachomatis (chlamydia) biovar L [ 1 ]. [doi.org]

• Complement Fixing Antibody

  The diagnosis of lymphogranuloma venereum was made by a fourfold rise in complement fixing antibody titer. Treatment with tetracycline was successful. [ncbi.nlm.nih.gov]

• Colitis

  The study of these special problems is of unique interest, because clarification of their particular pathogenesis may shed light on the development of the "idiopathic" variety of ulcerative colitis. [annals.org]

  Signs and symptoms associated with rectal infection can be mistaken for ulcerative colitis. Complications occur such as abscesses or fistulas occur when the infection becomes deep-seated. Stage Features 1 Small painless papule appears. [dermnetnz.org]

Doxycycline is the antibiotic of choice to treat LGV, unless the drug is contraindicated - Pregnant and lactating women should rather be treated with azithromycin or erythromycin. In general, a therapeutic regimen of 100 mg doxycycline once a day per os for three weeks is recommended. Azithromycin is given in a single dose of 1 g per os; erythromycin needs to be applied for three weeks in daily doses of 500 mg. Antibiotic resistances have rarely been reported and if patients comply with prescriptions, relapses are unlikely. However, long-term protection cannot be conferred and if patients don't avoid risk behavior, renewed infection is to be expected.

If buboes are present, they should be drained. Proper wound care is also recommended.

LGV patients generally respond well to antibiotic treatment and their prognosis is very good if such therapy is initiated before extensive, irreversible tissue damage occurs.

LGV is a sexually transmitted disease caused by serovars L1, L2 and L3 of C. trachomatis. This Gram-negative pathogen pertains to the family of Chlamydiaceae and is known to cause a variety of other pathologies, some of which are transmitted during sexual intercourse. In detail, the latter applies for urethritis, cervicitis, epididymitis and prostatitis. However, these entities are provoked by distinct serovars and may neither result from nor lead to LGV.

LGV may be contracted during unprotected vaginal, anal or oral sex. These transmission routes are of different epidemiological importance: Vaginal sex is practiced by heterosexual individuals, and provokes LGV in women and men. It is the classical route of transmission. Anal sex has always accounted for minor shares of LGV cases, but has evolved to be the main way of transmission in recent outbreaks in Europe, North America and Australia. In agreement with that observation, the majority of patients in these countries are men who have sex with men. Oral LGV has only been reported anecdotally [3], and the importance of ano-oral transmission in recent outbreaks is not yet clear [4].

LGV has traditionally been considered a public health concern in developing countries. Here, low educational levels, lack of medical attention and commercial sex work contribute to an increase in incidence and prevalence among the respective risk groups. More recently, several outbreaks of LGV have been registered in industrialized nations. Affected individuals are generally men who have sex with man, particularly if presenting a concomitant infection with HIV. Of note, the latter scenario is not unknown in underdeveloped regions. Highest case numbers have been reported from the United Kingdom and France [2]. And while the overall prevalence of LGV-associated serovars of C. trachomatis is much lower than that of other sexually transmitted strains [5] [6], almost one out of ten men who tested positive for C. trachomatis in the United Kingdom was indeed infected with an LGV-related serovar. Recent publications state that up to 25% of LGV patients remain asymptomatic; they may play an important role in epidemiology and serve as an undetected reservoir [7].

In general, women and men are equally susceptible to the disease. However, according to the above mentioned changes regarding risk groups and clinical presentation, males are diagnosed with LGV significantly more often than females in the Western world. With regards to age distribution, the sexually active population aged 15 to 40 years has a higher risk of contracting the disease than children and elder adults.

C. trachomatis is an obligate intracellular pathogen; it may be encountered in form of elementary bodies and reticulate bodies, which can be considered two developmental stages of the bacterium. Elementary bodies are infectious particles and may be transmitted during sexual intercourse. However, they are not metabolically active and require host cell structures in order to differentiate, grow and divide. Elementary bodies enter epithelial host cells within endocytic vacuoles after triggering cytoskeletal reorganization and induction of endocytosis [8]. Inside the host cell, elementary bodies differentiate into reticulate bodies. These are metabolically active, grow, divide, and eventually re-differentiate into elementary bodies. Upon cell lysis, the latter are released and may infect other cells of the same host or be transmitted to another human being.

In contrast to other strains, serovars related with LVG frequently pass through the mucosal barrier, travel to regional lymph nodes via lymphatic vessels, infect monocytes and macrophages, and induce a lymphoproliferative reaction. Within weeks after infection, lymph node abscesses may form.

Practice of safer sex is a very effective way to prevent LVG and a plethora of other sexually transmitted diseases, and people should be adequately educated about this topic. If possible, condoms should be provided. However, these contraceptives may not in any case cover all LVG-associated lesions and thus, transmission cannot be ruled out even if condoms are used - a residual risk remains. Avoidance of sexual intercourse with people at high risk of LVG is strongly recommended and eventually the only way to further minimize the risk.

Frequent changes of sexual partners and commercial sex work predispose for an infection. In order to reduce morbidity and disease prevalence, every affected individual should be treated with antibiotics. Periodic screening of asymptomatic men that pertain to any of the above mentioned risk groups can be realized by examination of rectal swabs and may largely contribute to identify otherwise unnoticed reservoirs.

Lymphogranuloma venereum (LGV) is a sexually transmitted disease that has long since been considered a rare disorder in developed countries. However, case numbers have been rising during the last decade and LGV has recently been classified as a re-emerging infectious disease [1].

The etiologic agent of LGV is Chlamydia trachomatis (C. trachomatis), namely serovars L1, L2 and L3. The disease is endemic in underdeveloped regions of Africa, India, Southeast Asia, Central and South America. Here, it generally manifests in form of genital ulcers and inguinal lymphadenopathy. Although antibiotics are highly effective against the causative pathogen, appropriate medical attention is generally delayed or not at all available in the aforementioned regions. Thus, morbidity due to extensive tissue damage, abdominal pain and long-term sequelae is high.

In contrast, LGV is rarely diagnosed in industrialized nations of Europe and North America. However, an outbreak that occurred in the Netherlands in 2004 marked a turning point with regards to LGV epidemiology in the Western world: The disease has subsequently been observed in other European countries, in North America and in Australia. Highest incidence rates have been reported in the United Kingdom [2]. Strikingly, the majority of these outbreaks has been provoked by serovar L2. Clinical presentation differed from the aforedescribed, classical one and was marked by complaints associated with proctitis or proctocolitis. Most patients were men who have sex with man, and a strong correlation between the incidence of LGV and previous infection with the human immunodeficiency virus (HIV) has been noted.

Lymphogranuloma venereum (LVG) is a sexually transmitted disease caused by serovars L1, L2 and L3 of Chlamydia trachomatis. It is important to note that other strains of this same species provoke distinct pathologies, i.e., inflammation of urethra, cervix, epididymis and prostate as well as conjunctivitis.

LVG may be contracted during unprotected vaginal, anal or - rarely - oral sex. Classic LVG manifests in form of genital or rectal ulcers and regional lymphadenopathy. Affected individuals pass through three stages of the disease: During the first stage, a papule may form on vulva, vaginal mucosa or cervix, on the glans penis, in the urethra or rectum of both women and men. It may erode and ulcerate, but is usually painless and doesn't cause pruritus. Thus, it frequently goes unnoticed. After about one week, it remits spontaneously. However, the infection persists, and symptoms corresponding to the second stage of the disease may be noted a few weeks later. By then, bacteria have reached regional lymph nodes, induce an inflammation accompanied by pain and swelling. Buboes may form. If not adequately treated, the disease may advance to a third, chronic stage marked by extensive tissue damage, abscess and fistula formation, and, in case of anal infections, inflammation, strictures and stenosis of the rectum.

While LVG has long since been considered an endemic disease of developing countries, several outbreaks have been registered in recent years in Europe, North America and Australia. The vast majority of affected individuals were men who have sex with man, whereby many of them were also infected with the human immunodeficiency virus. In these cases, an inflammation of the rectum or rectum and colon predominated the clinical picture. Patients may not anorectal bleedings, hemopurulent discharge, and problems while defecating.

LVG is effectively treated with antibiotics. If therapy is initiated before irreversible tissue damage occurs, the prognosis is excellent and long-term sequelae are not to be expected.

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